老年脓毒症患者免疫调理治疗前后T淋巴细胞亚群的变化

Changes of lymphocyte subsets in elderly patients with sepsis before and after immune modulation therapy

目的:研究老年脓毒症患者免疫调理治疗前后T淋巴细胞亚群的变化,为脓毒症的治疗提供依据。方法:76例65岁以上的老年脓毒症患者随机分为对照组,包括常规治疗组(常规治疗,n=38)和治疗组(常规治疗基础上每日加用1.6mg胸腺肽α1皮下注射,治疗15d,n=38);另选20例65岁以上健康老年人作为正常组。分别在用药前后测定各组研究对象淋巴细胞亚群比率。结果:治疗前,与正常组比较,对照组和治疗组患者T淋巴细胞(CD3+)、辅助性T淋巴细胞(CD4+Th)、CD4+Th亚群1(Th1)、B淋巴细胞(CD19+)、自然杀伤细胞(NK)比率、辅助性T淋巴细胞与抑制性T淋巴细胞比值(CD4+/CD8+)明显降低(P<0.01);调节性T淋巴细胞(Treg)和CD8+比率升高(P<0.05或P<0.01),CD4+Th亚群2(Th2)比率有升高趋势,但组间比较差异无统计学意义(P<0.05)。对照组和治疗组患者各项指标比较差异均无统计学意义(P>0.05)。治疗后,与对照组比较,治疗组患者血浆CD3+、CD4+Th和Th1比率明显升高(P<0.05或P<0.01),CD4+/CD8+比值、CD19+和NK细胞比率有升高趋势(P>0.05);CD8+细胞比率下降(P<0.05),Th2和Treg细胞比率有下降趋势(P>0.05)。结论:与健康老年人比较,老年脓毒症患者淋巴细胞总数减少,淋巴细胞亚群比例失衡。胸腺肽α1能增加老年脓毒症患者淋巴细胞总数,改善淋巴细胞亚群比例失衡。

Objective To investigate the changes of lymphocyte subsets in the elderly patients with severe sepsis before and after immune modulation therapy,and to provide the basis for curing the disease.Methods 76 patients older than 65 years were enrolled and randomly divided into control group（n=38）and treatment group（n=38）.All patients were received conventional therapy and the patients in treatment group were received 1.6mg thymosin alpha-1through subcutaneous injection once a day for 15 d.20healthy individuals older than 65 years were selected as healthy group.The lymphocyte subsets of objects in groups were measured before and after treatment.Results Before treatment,the ratios of CD3^＋,CD4^＋,Th1,CD4^＋/CD8^＋,CD19^＋,NK of the patients in control and treatment groups were significantly decreased and the ratios of Treg and CD8^＋were significantly increased compared with healthy group（P〈0.05 or P〈0.01）;the ratios of Th2 was mildly increased in the patients in various groups,but these parameters of the patients had no significant differences between control group and treatment group（P〉 0.05）.After treatment,the ratios of CD3^＋,CD4^＋,and Th1 were significantly increased while the ratios of CD8^＋was significantly decreased of the patients in treatment group compared with control group（P〈0.05 or P〈0.01）;the ratios of CD4^＋/CD8^＋,CD19^＋,and NK cells were mildly increased while the ratios of Th2 and Treg were mildly decreased of the patients in treatment group compared with control group,but there was no statistically difference（P〉0.05）.Conclusion Compared with healthy aged persons,the lymphopenia and lymphocyte subsets imbalance exist in the elderly patients with severe sepsis.Thymosin alpha-1can regulate the quantity and proportion of lymphocyte subsets in the elderly patients with severe sepsis.